Intragraft pressures predict outcomes in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty.

摘要

OBJECTIVES: This study is to introduce intragraft pressure (IGP) as intraprocedural parameter for outcome survey in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty (PTA). BACKGROUND: The role of IGP on procedural endpoint and patency is unknown. METHODS: Seventy-five participants with graft outflow lesions receiving PTA were enrolled. Procedural data regarding IGP and angiographic findings were collected and the 1-year graft patency through collaboration with hemodialysis units. Analyses and comparisons among IGP, angiographic findings, and patency were conducted. Using the receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis, we intended to detect significance and the cut-off points of IGP for patency prediction, and difference in patency between the two groups divided by using the cut-off points. RESULTS: Pre-PTA and post-PTA IGP were significantly associated with 1-year patency (both significance <0.01) with 0.756 and 0.791 areas under the ROC curves, respectively. The cut-off points of pre-PTA and post-PTA IGP were closer to 106 and 47 mm Hg for prediction of 1-year patency (sensitivity = 0.76, specificity = 0.69; sensitivity = 0.79, specificity = 0.69, respectively; 95% CI). Significant reductions in 1-year patency were shown in the subjects with greater than the cut-off values, either pre-PTA or post-PTA IGP, compared with those with smaller than these values (both log rank test < 0.001). CONCLUSION: IGP might be useful to evaluate procedural endpoints and predict patency outcomes in hemodialysis patients with graft outflow lesions undergoing PTA. Patients with the greater pre-PTA or post-PTA IGP, to some level, seem to have the shorter patency.